Provider Demographics
NPI:1265830996
Name:FLINCHUM, SASHA
Entity Type:Individual
Prefix:
First Name:SASHA
Middle Name:
Last Name:FLINCHUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 610
Mailing Address - Street 2:
Mailing Address - City:CLAY CITY
Mailing Address - State:KY
Mailing Address - Zip Code:40312-0610
Mailing Address - Country:US
Mailing Address - Phone:606-663-3481
Mailing Address - Fax:
Practice Address - Street 1:4644 HIGHWAY 15 WEST
Practice Address - Street 2:
Practice Address - City:CLAY CITY
Practice Address - State:KY
Practice Address - Zip Code:40312
Practice Address - Country:US
Practice Address - Phone:606-663-3481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-11
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY017163183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist